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Published on: September 13, 2014
Liver Transplantation Using an Iliac Artery Graft for a Patient With a Celiac Artery Aneurysm: A Case Report
Jiro Kimura1, Prakash Chauhan1, Matthew Cooper1
1Transplant Surgery, Medical College of Wisconsin, Milwaukee, USA.
Insights
Celiac artery aneurysms pose a high rupture risk. Liver transplantation (LT) using an iliac artery conduit successfully addressed this rare condition, ensuring adequate hepatic artery inflow and preventing vascular complications.
Area of Science:
- Vascular Surgery
- Hepatobiliary Surgery
- Transplantation Surgery
Background:
- Celiac artery aneurysms are rare but dangerous visceral artery aneurysms.
- Arterial complications are significant risks after liver transplantation (LT).
- Maintaining adequate hepatic artery inflow is critical for LT success.
Observation:
- A patient with alcoholic cirrhosis presented with a celiac artery aneurysm with dissection.
- Standard hepatic artery reconstruction was not feasible due to the aneurysm.
- An iliac artery conduit was used for hepatic artery reconstruction during LT.
Findings:
- The iliac artery conduit provided a successful vascular connection between the aorta and the implanted hepatic artery.
- Postoperative imaging confirmed the patency of the iliac artery conduit.
- The patient experienced an uneventful recovery without vascular complications.
Implications:
- Using an iliac artery conduit for LT in patients with celiac artery aneurysms is a safe and feasible option.
- This technique offers a promising alternative for graft vascularization in complex cases.
- It highlights the adaptability of vascular reconstruction strategies in transplantation surgery.
Abstract:
Celiac artery aneurysm is a rare entity among the visceral artery aneurysms, with a high risk of rupture, resulting in high mortality. Arterial complications, such as thrombosis, dissection, and hemorrhage, are among the most serious complications after liver transplantation (LT), which can lead to abscess formation, ischemic cholangiopathy, and hepatic ischemia and necrosis. Therefore, an adequate inflow of the hepatic artery is crucial to avoid any occlusion after LT. When a normal arterial anastomosis is not appropriate, the use of an artery conduit is an important option for graft vascularization. Herein, we present a patient who underwent LT using an iliac artery conduit due to a celiac artery aneurysm. A 53-year-old man with a history of alcoholic cirrhosis presented to the Emergency Department of our institution with abdominal pain and jaundice. He was diagnosed with alcoholic cirrhosis and admitted to our hospital the same day. A preoperative contrast-enhanced computed tomography (CT) scan revealed a celiac artery aneurysm with dissection. Therefore, hepatic artery reconstruction with an iliac artery conduit was planned. Twenty days after the initial visit, he underwent transplantation. At the time of surgery, the supraceliac aorta was exposed after his native liver was explanted. After cavo-cavostomy and portal vein anastomosis were performed, the iliac artery conduit was anastomosed with the supraceliac aorta and the implanted common hepatic artery, with a running suture. On postoperative day 2, the patency of the iliac artery conduit was confirmed by contrast-enhanced CT scan. His postoperative course was uneventful, without any vascular complications. For patients with a celiac artery aneurysm, the use of an iliac artery conduit in LT can be performed safely. This approach may become a promising alternative for future treatment.
